CITY OF SAINT PAUL                           
                                               P.O. BOX 901 
                              ST. PAUL ISLAND, ALASKA 
                                               99660-0901 
                                               (907) 546-3121 
                                         FAX (907) 546-3199 
                    
                  APPLICATION FOR A CERTIFICATE OF REGISTRATION 
             The Undersigned makes application for a certificate of authority to collect Sales Tax  
                             and submits the following information: 
Name of Applicant/Business:  

Mailing Address:             

State:                                                        Zip Code:              

Is this a renewal of a previous registration?:              Yes                  No 
If this is a renewal and there are no changes from the previous year, your signature, printed name, application 
fee and a copy of your AK Business License complete this application. Please mail to the address above. 
Date Business was Started or Purchased:   

Type of Business:                         

AK Business License Number:               

(Fill out a separate application for each ABL Number)       
Type of Ownership: Individual      Co-Partnership     Corporation   LLC  Other (specify):  
Are you the owner of the premises where your business is conducted?      Yes     No                  
Owner:     

List the name(s) and home address(es) of the owner, partners, or corporate officers: 
             Name                              Title                                Home Address 
                                                               
List all locations where you conduct business: 
        Business Name                                          Location 
                              
I HEREBY CERTIFY that the statements herein have been examined by me and are, to the best of my 
knowledge and belief, true and complete. 
                                                               
Signature                                                     Title 
                                                               
Printed Name                                                  Date 
Please submit this form to the City of Saint Paul by January 15 of each year for renewal, or within 24 hours of 
 starting a business operation within the City limits. Failure to register on time may result in a $300 initial 
       penalty and up to $300 per day of operation without a certificate (Ch. VII – Sales Tax, Sec. 7.6).   
                            A $40 fee must accompany this form.